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GENERAL PRACTITIONER'S SECTION
BREAST-FEEDING — A COMMUNITY RESPONSIBILITY
DEEPA H VELANKAR
1) Every child should be breast-fed. Start breast-feeding within one hour of birth in normal delivery and within 4 hours in C-section delivery. 2) Exclusive breast-feeding for first 4 months of life, no need for any supplements. Continue breast-feeding into 2nd year of life. 3) Avoid bottle-feeding at all ages. Use katori (cup) or spoon if required. 4) Weaning should be started after 4 months of life and definitely not later than 6 months. 5) Infants who are not breast-fed are more likely to become ill and die than those who are. 6) Bottle-feeding is harmful. 7) Working mothers should also breast-feed. 8) Violation of law by advertising and promotion of infant milk substitutes, bottle-feeding can be fined or imprisoned. 9) World Breast-Feeding Week should be organized every year.10) It is the responsibility of the community as a whole to promote breast-feeding.
INTRODUCTIONBreast-feeding is the natural and ideal way of feeding the infant. It provides a unique biological and emotional basis for the healthy development of the child. In view of changes in society and social institutions, breast- feeding practice is being given less importance among certain groups of women. Other factors such as women’s education, media and workplace environment also influence their decisions to breast- feed. But if breast-feeding mothers are aptly supported by their family members, friends and health workers and by the community at large, this practice could regain its importance. Therefore it becomes our prime responsibility, as members of the community, to support breast feeding culture so that the young and newborns grow up to become healthy citizens.
Disturbing Facts
Infant feeding practices done over 10,000 infants,
IMA study 1991
— 33% infants received bottle feeds during first month of life.
— Only 20% babies were exclusively breast-fed during first 4 months of life.
— 66% infants were on bottle feeds by 6 months of life.
— 75% infants started to breast-feed 6 hours after birth.
— 25% infants did not receive solid food even at 1 year of age.
Consensus Documents
This document on infant nutrition has been supported by leading national and international professionals, pioneers in infant feeding research, advocates, academic bodies and social activists. Its aim is to bring about uniformity in infant nutrition practices. The recommendations of this Document are:
1) Start breast-feeding within one hour of birth in normal deliveries and within 4 to 6 hours in caesarian section deliveries.
2) Only mother’s milk is required till the child completes 4 months i.e.Exclusive Breast-Feeding. No need for any supplements of water, milk or other fluids and foods.
3) To be successful in breast-feeding avoid bottlefeeding.
4) Add solid foods after the age of 4 months i.e. weaning. Along with solids continue breastfeeding well upto 2years of life.
Bottle-Feeding is Harmful
1) Increases morbidity and mortality amongst children, especially from diarrhoea. Risk of death from diarrhoea is 14 times higher in bottle-fed babies.
2) Bottle-fed children are more prone to develop asthma and allergies.
3) Wastes the natural resource of mother’s milk- estimated loss being 1100 million liters annually.
Breast-Feed Your Baby
Breast-milk is the perfect food made for your baby.
B - best for the child as it is safe, clean and hygienic.
R - readily available on demand whenever the baby is hungry.
E - essential elements are present like antimicrobial factors such as macrophages, lymphocytes, secretory IgA, anti-streptococcal factor, lysozyme and lactoferrin.
A - acceptable socially.
S - satisfaction to mother.
T - temperature is just right.
F - free from contamination.
E - economical as cheap and free of cost.
E - emotional bond between mother and child.
D - disease prevented as gastrointestinal and respiratory tract infections.
I - involution of uterus is faster.
N - no to contraceptives as prolonging the period of infertility.
G - growth both physical and mental is normal.
Working Mothers and Breast-feeding
1) Take as much as maternity leave as possible after birth.
2) Breast-feed exclusively for first 4 months of life or at least as long as the leave is available.
3) Make sure breast-feeding is well established before you return to work.
4) Practice expressing breast-milk before you return to work. Expressed breast-milk (EBM) can be stored at room temperature for 8 hours and in the refrigerator for 24 hours, expression by hand is easier. 5) Expressed breast-milk should be given to the baby by the
caretaker with a katori (cup) or spoon, not with a bottle as bottle-fed babies lose interest in breastfeeding. If EBM is not sufficient for the baby, milk other than breast-milk may be used. 6) Breast-fed more at night. It will easier for you if the baby sleeps with you. 7) If your workplace is near, try taking a breast-feeding break from the employer. 8) Share child-care by forming mother support groups with
other working women in the community. 9) Delay your next pregnancy for at least three years. 10) Help women to get back into shape faster.
Baby Food Code
The Infant Milk Substitutes, Feeding Bottles and Infant Foods, (Regulation of Production, Supply and Distribution) Bill,1992 is enacted as a law now. The Bill received assent of the President on Dec.29 1992, after years of hard work and continued efforts made by all concerned with children’s future. The Bill recognizes the role of inappropriate feeding practices to be a cause of high infant morbidity and mortality and need for protection and promotion of breast-feeding in our country. In short the Bill aims to regulate production, supply and distribution of infant milk substitutes, infant foods and feeding bottles and banning their advertisements with a view to promote breast-feeding. The crucial battle against the bottle, calls for attention from all quarters. The effective implementation and monitoring of the code is urgent need of the hour. It is time to act for all of us who believe in welfare of the nation.
The Bill has following provisions: 1) It bans all advertisements of infant milk substitutes and feeding bottles. 2) It forbids display of posters/placards for promotion of infant-milk substitutes, infant foods or feeding bottles in hospitals or other health care facilities. 3) It does not permit the container or the label to have picture of an infant or a woman or both. 4) It makes it mandatory for every container to carry the message “Mother’s Milk is Best For Your Baby”, and the tin food should be used on the advice of a health worker. 5) It prescribes measures to ensure that in the marketing of infant milk substitutes, no impression is given that feeding of these products is equivalent to or better than breastmilk. No words like “Humanised” or “maternalised” can be used on the tin. 6) It forbids the manufacturer, distributor or supplier to give any direct or indirect financial inducements to health care personnel for the purpose of promoting the use of infant milk substitutes, infant foods or feeding bottles. 7) It forbids all persons from supplying or distributing samples of infant milk substitutes, infant foods or feeding bottles, to give any commission or financial inducement to the workers for promoting sales of these. 9) It has a penalty provisions of a fine of upto Rs.5000 or imprisonment upto three years or both for violation of the law.
We need to standup against the aggressive marketing of infant milk formula products, on which depends the health of millions of our children. Every citizen must monitor the implementation of the Bill.
World Breast-feeding Week (WBW) is organized every year from 1st August to 7th August, by the World Alliance for Breast-feeding Action (WABA) to strengthen the breast-feeding culture. WBW provides an opportunity for all of US- family members, teachers, media personnel, religious leaders, doctors, health-workers, policy makers and BPNI (Breast-feeding Promotion Network of India) members and others to evaluate prevailing attitudes towards breast-feeding in our communities and give them a positive orientation.
Goals of WBW : 1)To advocate a community approach to support breast-feeding. 2) To work with all sections of the community and develop ways for restoring the breast-feeding culture.
Approach of WBW activities : 1) Assess - To Look: Take a look at the situation and talk to various groups of people such as family members, health-workers etc. 2) Analyse - To Think: Think about the problem and the gaps. Also think about good practices which would support breast-feeding mothers. 3) Act - To do: Design activities to dispel misinformation, set up support groups and fill gaps by involving opinion makers in the community.
ROLE OF COMMUNITY IN PROMOTING
BREAST-FEEDING
1) Family Members can play a vital role. They can be a source of inspiration to pregnant and lactating mothers. Helping her out with household chores when she is breast-feeding. Appreciating the fact that she needs extra food and rest. Fathers should seize the opportunity to build a life time bond with your children by feeding, bathing and cuddling them. Grandmothers and mother-in laws should appreciate and support the decision made by mothers to breastfeed.
2) Teachers - Catch them young: Can create awareness regarding breast-feeding and help to sensitize the young generation by imparting information about breast-feeding. Modifying curricula to include chapters on breast-feeding in biology and health classes at secondary school and college levels. Organizing debates on various aspect of breast-feeding as opposed to bottlefeeding; the systems supporting breast-feeding and helping working mothers to continue breast-feeding successfully.
3) Media and Advertising Agencies - Project a baby friendly image: They can help in publishing World Breast-Feeding Week activities. Avoid projecting a bottle-feeding image of the mothers. Encourage advertising agencies and producers to design and develop promotional programmes and slogans. Visit 5 work places and conduct a quick survey to see if there are creches and other facilities necessary for breast-feeding.If involved with advertising, be aware 1) Of the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production and Distribution) Act, 1992. 2) That advertising cereal foods should meet certain rules laid down under the Act. 3) Of the fact that advertising of infant formula is not allowed. The common man can screen advertisements to see if there is violation of the Act.
4) Religious leaders - Promote breast-feeding messages in your holy mission: They can support breast-feeding and propagate its importance. Include infant feeding messages in your discourses.
5) Doctors and Health-Workers - Strengthen your efforts: Check whether hospitals and maternity services in your area are baby friendly. Breastfeeding should be discussed with parents during pre and postnatal stages. Hospitals should not accept or distribute free samples of infant formula to mothers. They should report violations of the Act to the gazetted organizations under the Act. Consider adopting the Consensus Documents.
6) Policy makers - Mould public opinion : They can contribute by : a) supporting the formation of a national breast-feeding committee with representations from all concerned sectors. b) Supporting the recommendation that maternity leave should be increased to 6 months. c) Ensuring that women have a supportive work environment with creches and day care facilities, breast-feeding
breaks etc.
7) BPNI members - Now is the time to put plans into action: Assess the state of breast-feeding in your city. You can find out: a) The percentage of hospitals offering bottle or tin foods to newborns and report to headquarters. b) The approximate percentage of women bottle-feeding babies in the first 1-2 months. c) Which media supports breast-feeding and which does not control advertising of bottles/ bottle-feeds. d) How the community reacts to advocacy and what support it extends. e) What percentage of doctors give information on breast-feeding to pregnant women. f) The prevailing attitudes of policy makers, religious leaders and teachers on breast-feeding. You can plan well and take proper action by: a) Forming a committee. b) Mobilizing policy makers, religious
leaders and teachers to support breast-feeding. c) Holding press conferences and preparing press releases to ensure media coverage. d) Giving talks on radio and TV. e) Encouraging employers to provide breast-feeding breaks and facilities to lactating mothers. f) Getting a statement signed and motivating parents to adopt exclusive breast-feeding at least for first 4 months of life give appropriate complementary feeding after 4 months.
CONCLUSION
Conflicting messages on infant nutrition over the years have caused a great deal of confusion among mothers. It is the baby who loses out. Therefore the community as whole has responsibility to protect the infants of this Nation. Therefore share the message with every mother you come into touch with, “Breast-Feed Because Every Baby Deserves The Best Start in Life.”
REFERENCES
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3. UNICEF: The State of the World’s Children, New York, UNICEF, 2000.
4. Park’s Textbook of PSM: K.Park, 17th edition, chapter no.9, 2003; 373.
5. Shanti Ghosh : The feeding and care of infants and young children, UNICEF, New Delhi, 1976.
6. Anne-Marie Masse-Raimbanet, Children in tropics, Feeding babies: From breast-milk to the family dish, 1992; 202-203.
7. Helsing E, King FS. Breast-feeding in Practice, Oxford University Press, New Delhi, 1984.
8. Govt of India CSSM review, 1995; 25.
9. WHO: Measuring changes in nutritional status, 1983.
10. WHO: Towards a better future, MCH, 1980.
